Admission White Blood Cell Count Predicts Short- and Long-Term Mortality in Patients With Acute Aortic Dissection: Data From the MIMIC-III Database

Background: Inflammation underlies both the pathogenesis and prognosis in patients with acute aortic dissection (AAD). This study aimed to assess the association of ICU admission of white blood cell count (WBCc) with short- and long-term mortality in these patients. Methods: Clinical data were extracted from the MIMIC-III V1.4 database. After adjusted to covariables, Cox regression analysis and Kapan-Meier curve were performed to determine the relationship between WBCc on admission and short- and long-term mortality in AAD patients. Subgroup analysis and receiver operating characteristic (ROC) curve analysis were conducted to evaluate the performance of admission WBCc in predicting short- and long-term mortality in patients with AAD. Results: A total of 325 eligible patients were divided into 2 groups: normal-WBCc group(≤ 11 k/uL) and high-WBCc group(>11 K/uL). In univariate Cox regression analysis, high WBCc was significant risk predictor of 30-days, 90-days, 1-year and 5-years mortality [hazard ratio(HR), 95%CI, P 2.58 1.36–4.91 0.004; 3.16 1.76–5.70 0.000; 2.74 1.57–4.79 0.000; 2.10 1.23–3.54 0.006]. After adjusting for age and other risks, high WBCc remained a significant predictor of 30-days, 90-days and 1-year mortality in AAD patients (HR, 95% CI, P 2.55 1.23–5.27 0.012; 2.88 1.44–5.76 0.003; 2.33 1.21–4.47 0.011). The area under ROC curve of WBCc for predicting 30-days, 90-days, 1-year and 5-year mortality were 0.69, 0.70, 0.66 and 0.61, respectively. The results from subgroups analysis showed that there was no interaction in most strata and patients who were younger than 69 years of age or had history of respiratory disease with an elevated WBCc had an excess risk of 30-days mortality (HR, 95% CI:, P 3.18 1.41–7.14 0.005; 3.84 1.05–14.13 0.043). Conclusion: A marked elevated WBCc on admission can predict short- and long-term mortality in patients with AAD.